Abstract
BackgroundTreatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients’ motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population.Methods/designThe Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT) is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients’ treatment motivation upon the patients’ TE. The primary outcome is the patients’ TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual) will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician) and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded.DiscussionThe current study can provide important insights regarding motivational processes and the way in which motivation influences the treatment engagement and clinical outcomes. The identification of possible mechanisms through which changes in the outcomes occur, offers a tool for the development of more effective future interventions to improve TM and TE.Trial registrationCurrent Controlled Trials NTR2968
Highlights
Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness
Since patients with psychotic disorders constitute the majority of patients treated in assertive community mental health teams in the Netherlands [33,36] and patients with severe personality disorders constitute another significant part of the caseload, combined with clinical observations that these two diagnostic groups may especially benefit from interventions aimed at improving treatment motivation and treatment engagement, it was decided to incorporate both patient groups into the study
The central research question in this study is whether the motivation feedback intervention is able to increase the treatment engagement of patients in outpatient psychiatric treatment for severe mental illness
Summary
The central research question in this study is whether the motivation feedback intervention is able to increase the treatment engagement of patients in outpatient psychiatric treatment for severe mental illness. Actively involved in the treatment as they expect it to work, which may enhance the effect of the intervention we find This would especially be the case for the subjective (i.e. self-report) outcome measures that are administered to patients and clinicians, but less so for the objective outcome measures (e.g. number of no shows and drop-out as registered by the institution’s administrative system). The DSM-IV diagnosis is not established with structured diagnostic interviews, but is obtained from the patients’ medical records This choice was made to reduce patient burden, since structured interviews were considered too extensive and time-consuming in combination with the other instruments used in this study
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